OB-GYN-L Messages for November, 2006: Re: ACOG Statement

Re: ACOG Statement

From: Ina May Gaskin

midwifeim@earthlink.net

Wed Nov 15 09:55:29 2006

ACOG's continued statements on home (now adding birth center) birth are meant to distract from the real debate that should be happening in light of rising rates of maternal and perinatal mortality here. Most of our states don't even have state-wide maternal mortality review committees. How can we avoid repeating mistakes which cost lives when we don't even require accurate reporting of maternal deaths? The CDC hasn't been able to tell us that the underreporting of maternal deaths has improved at all since 1998, when they warned that their numbers were seriously inaccurate (wrong by a factor of 1.3 to 3, by their best estimate!). See Maternal mortality rate grossly underestimated, Ob.Gyn News, January 11, 2000; Maternal mortality — United States, 1982-1996. The Morbidity and Mortality Weekly Report 1998;47:34,705-7. Why does ACOG issue no statement about this serious problem if it cares so much about the safety of women and babies? The honor system obviously isn't working. The ACOG could follow the example of the RCOG, its counterpart in the UK, which publishes Why Mothers Die every third year as part of its work with the Confidential Enquiries into Maternal Deaths.

-- Ina May Gaskin, CPM, MA http://www.rememberthemothers.net

On Nov 15, 2006, at 6:26 AM, Lynn Montgomery MD wrote:

> I also do not want to engage in a debate regarding this subject. > However, I do feel that I need to say a few things about it. > > First of all, ACOG is wrong with regard to the evidence about “out > of hospital births”. First, I would point out that outside of the > confines of the United States, the vast majority of births occur > “out of hospital”. Now this varies anywhere from mud huts to home > births to maturnity centers. Unfortunately, with all of our > arrogance regarding our hospital system, including our technology, > the United States still ranks 12 in perinatal outcomes in the > world. Further, a study published in the New England Journal of > Medicine in ’89, reviewed births undertaken in a birth center > setting, demonstrating the safety, as well as a dramatically lower > cesarean section rate and excellent outcomes. In June 2005, the > British Medical Journal published an article comparing 5000 low > risk births delivered in a hospital setting in the United States > and Canada and matched them with 5,000 out of hospital matched low > risk births. The studies conclusion was that it was safer to > deliver a low risk pregnancy out of the hospital and the cesarean > section rate was 30% in the hospital group, compared with 5% in the > out of hospital births. > > Birth Centers across the country, of which there are approximately > 180, are accredited by the American Association of Childbearing > Centers. Their oversight includes strict adherence to policies and > procedures, combined with site visits, etc. In addition, they > meticulously database their outcomes, which, for over 20 years, > have continued to reinforce the safety. The incidence of truly > acute transfers from an accredited birth center is less than 1% and > those outcomes are predominantly good – which is more than I can > say for any hospital setting. > > Finally, I would add that it is very disappointing to me that ACOG > wastes its time, energy and money issuing statements such as this > recent example, yet remain essentially impotent with regard to > liability reform, reimbursement and the rights of an OB/GYN. > > Lynn >

use when must restrict search to only the ob-gyn-l forum...
Enter search keywords:
	Returns per screen: Require all keywords: